Juan Manuel Pascasio1, Carmen Vinaixa2, María Teresa Ferrer1, Jordi Colmenero3, Angel Rubin2, Lluis Castells4, María Luisa Manzano5, Sara Lorente6, Milagros Testillano7, Xavier Xiol8, Esther Molina9, Luisa González-Diéguez10, Elena Otón11, Sonia Pascual12, Begoña Santos4, José Ignacio Herrero13, Magdalena Salcedo14, José Luis Montero15, Gloria Sánchez-Antolín16, Isidoro Narváez17, Flor Nogueras18, Álvaro Giráldez1, Martín Prieto2, Xavier Forns3, María-Carlota Londoño19. 1. UGC Digestive Diseases, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, Spain. 2. Liver Unit, Digestive Medicine Service, Hospital Universitario La Fé, CIBERehd, Valencia, Spain. 3. Liver Unit, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain. 4. Internal Medicine Service, Hospital Universitari Vall d'Hebron, CIBERehd, Barcelona, Spain. 5. Digestive Diseases Service, Hospital Universitario 12 Octubre, Madrid, Spain. 6. Liver Transplant Unit, Digestive Diseases Service, Hospital Universitario Lozano Blesa, Zaragoza, Spain. 7. Liver Unit, Digestive Diseases Service, Hospital Universitario Cruces, Vizcaya, Spain. 8. Digestive Diseases Service, Hospital Universitari Bellvitge, Barcelona, Spain. 9. Abdominal Transplant Unit, CHU Santiago de Compostela, IDIS, Santiago, Spain. 10. Liver Unit, Hospital Universitario Central de Asturias, Asturias, Oviedo, Spain. 11. Digestive Diseases Service, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain. 12. Liver Unit, Hospital General Universitario, CIBERehd, Alicante, Spain. 13. Liver Unit, Clínica Universitaria de Navarra, CIBERehd, IdiSNA, Pamplona, Spain. 14. Liver Transplant Unit, Hospital General Universitario Gregorio Marañón, CIBERehd, Madrid, Spain. 15. UGC Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, Spain. 16. Liver Transplant Unit, Hospital Universitario Río Ortega, Valladolid, Spain. 17. Digestive Diseases Service, Hospital Universitario Infanta Cristina, Badajoz, Spain. 18. Digestive Diseases Service, Hospital Universitario Virgen de las Nieves, Granada, Spain. 19. Liver Unit, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain. Electronic address: mlondono@clinic.ub.es.
Abstract
BACKGROUND & AIMS: Antiviral therapy for the treatment of hepatitis C (HCV) infection has proved to be safe and efficacious in patients with cirrhosis awaiting liver transplantation (LT). However, the information regarding the clinical impact of viral eradication in patients on the waiting list is still limited. The aim of the study was to investigate the probability of delisting in patients who underwent antiviral therapy, and the clinical outcomes of these delisted patients. METHODS: Observational, multicenter and retrospective analysis was carried out on prospectively collected data from patients positive for HCV, treated with an interferon-free regimen, while awaiting LT in 18 hospitals in Spain. RESULTS: In total, 238 patients were enrolled in the study. The indication for LT was decompensated cirrhosis (with or without hepatocellular carcinoma [HCC]) in 171 (72%) patients, and HCC in 67 (28%) patients. Sustained virologic response (SVR) rate was significantly higher in patients with compensated cirrhosis and HCC (92% vs. 83% in patients with decompensated cirrhosis with or without HCC, p=0.042). Among 122 patients with decompensated cirrhosis without HCC, 29 (24%) were delisted due to improvement. No patient with baseline MELD score >20 was delisted. After delisting (median follow-up of 88weeks), three patients had clinical decompensations and three had de novo HCC. Only two of the patients with HCC had to be re-admitted onto the waiting list. The remaining 23 patients remained stable, with no indication for LT. CONCLUSIONS: Antiviral therapy is safe and efficacious in patients awaiting LT. A quarter of patients with decompensated cirrhosis can be delisted asa result of clinical improvement, which appears to be remain stable in most patients. Thus, delisting is a safe strategy that could spare organs and benefit other patients with a more urgent need. LAY SUMMARY: Antiviral therapy in patients awaiting liver transplantation is safe and efficacious. Viral eradication allows removal from the waiting list of a quarter of treated patients. Delisting because of clinical improvement is a safe strategy that can spare organs for patients in urgent need.
BACKGROUND & AIMS: Antiviral therapy for the treatment of hepatitis C (HCV) infection has proved to be safe and efficacious in patients with cirrhosis awaiting liver transplantation (LT). However, the information regarding the clinical impact of viral eradication in patients on the waiting list is still limited. The aim of the study was to investigate the probability of delisting in patients who underwent antiviral therapy, and the clinical outcomes of these delisted patients. METHODS: Observational, multicenter and retrospective analysis was carried out on prospectively collected data from patients positive for HCV, treated with an interferon-free regimen, while awaiting LT in 18 hospitals in Spain. RESULTS: In total, 238 patients were enrolled in the study. The indication for LT was decompensated cirrhosis (with or without hepatocellular carcinoma [HCC]) in 171 (72%) patients, and HCC in 67 (28%) patients. Sustained virologic response (SVR) rate was significantly higher in patients with compensated cirrhosis and HCC (92% vs. 83% in patients with decompensated cirrhosis with or without HCC, p=0.042). Among 122 patients with decompensated cirrhosis without HCC, 29 (24%) were delisted due to improvement. No patient with baseline MELD score >20 was delisted. After delisting (median follow-up of 88weeks), three patients had clinical decompensations and three had de novo HCC. Only two of the patients with HCC had to be re-admitted onto the waiting list. The remaining 23 patients remained stable, with no indication for LT. CONCLUSIONS: Antiviral therapy is safe and efficacious in patients awaiting LT. A quarter of patients with decompensated cirrhosis can be delisted asa result of clinical improvement, which appears to be remain stable in most patients. Thus, delisting is a safe strategy that could spare organs and benefit other patients with a more urgent need. LAY SUMMARY: Antiviral therapy in patients awaiting liver transplantation is safe and efficacious. Viral eradication allows removal from the waiting list of a quarter of treated patients. Delisting because of clinical improvement is a safe strategy that can spare organs for patients in urgent need.
Authors: Juliet A Emamaullee; Mariusz Bral; Glenda Meeberg; Aldo J Montano-Loza; Vincent G Bain; Kelly Warren Burak; David Bigam; A M James Shapiro; Norman Kneteman Journal: Can J Gastroenterol Hepatol Date: 2019-01-17
Authors: Chiranjeevi Gadiparthi; George Cholankeril; Brandon J Perumpail; Eric R Yoo; Sanjaya K Satapathy; Satheesh Nair; Aijaz Ahmed Journal: World J Gastroenterol Date: 2018-01-21 Impact factor: 5.742